At a time when rights violations and threats to democracy are deepening, it is necessary to defend the fundamental role of care. With this in mind, we present this Letter from Manguinhos[1], a region of the city of Rio de Janeiro, Brazil, where Fiocruz[2] and, much more drastically, many favelas and poor communities have been constantly hit by despicable and violent war-on-drugs policies that criminalize drug users and authorize warlike actions on whole populations, like in so many other marginalized regions across Latin America and the world.

The world is currently witnessing a rise in conservative forces which, in Latin America, has translated into the weakening of democratic processes; the deepening of socioeconomic inequities; and an exacerbation of social breakdown and segregation. Taken together, such dynamics risk undermining fundamental rights. One emblematic example is the recent intervention that took place in the District of Luz, in the city of São Paulo. For four years, a multisectoral project inspired by the principles of harm reduction aimed to articulate actions to guarantee the right to housing, work / income and care in the region known as "cracolândia." A police operation aimed at "social cleansing" took place in May 2017, using moral panic to serve the interests of real estate speculators. This was followed by weeks of violence and arbitrary actions against socially vulnerable people living in extreme poverty, labeled as "crack addicts." A public policy focusing on care, health and promoting rights was thus replaced with repression and rights violations.

Such arbitrariness is not limited to Brazil – similar cases can be found in many areas of Latin America, where the presence of drugs serves as a pretext for territorial intervention. Other forms of structural violence include difficulties in accessing public services, murders, incarceration, exposure to infectious diseases, lack of access to medicines and absence of policies that aim to protect citizens’ rights.

Because of their focus on promoting health, citizenship, the right to access the city, social justice and drug users’ human rights, harm reduction policies have not been exempt from the effects of the conservative juncture. The current drug policy model is implemented selectively, by specifically criminalizing, imprisoning and stigmatizing the poorest groups living in marginal regions, homeless people, black and/or indigenous people, as well as women and youth.

Successful approaches focusing on care reject the interventionist violence defended by conservative policies. The evidences, ethic and political knowhow of harm reduction reject policies that fail to recognize the diversity of human experience and only rely on biomedical rationality and the criminalization of what is considered to be divergent behaviors. The harm reduction interventions that we are carrying out in our daily lives across the continent - and perhaps in other parts of the world - represent a concrete alternative to failed binary and simplistic concepts and interventions. It is nevertheless necessary to move even further towards a multisectoral harm reduction approach that is capable of articulating support for drug policy reform with the struggles of women, blacks, indigenous peoples, LGBTI and youth.

Given this situation, we propose a harm reduction approach grounded in decriminalization and emancipation, in which subjective and corporeal experiences are no longer exposed to repressive and disciplinary actions. Harm reduction is a powerful tool to question current models of control, and includes the promotion and respect for the freedom and autonomy of people who use drugs.

We consider it urgent to share our experiences and resistance, and promote a dialogue in Latin America - and elsewhere - with the view of consolidating our argument in defense of public harm reduction policies as they relate to drug policy reform.

The following organizations and institutions sign the Letter from Manguinhos:

Institutional Program on Alcohol, Crack and other Drugs of Oswaldo Cruz Foundation - PACD/Fiocruz (Brazil)

[1] Manguinhos, a neighborhood in which the Oswaldo Cruz Foundation (Fiocruz) is located, began to form itself in the beginning of the 20th century, after the removal of favelas and slums from the city center, part of the process of sanitation and modernization of the city of Rio de Janeiro. Today, Manguinhos brings together more than 40,000 inhabitants, and is one of many popular territories victimized by the multiple forms of violence engendered in the context of war on drug policy throughout Latin America.

[2] Oswaldo Cruz Foundation (Fiocruz) is the largest brazilian health research institution, founded in the year of 1900. Its main campus in Rio de Janeiro is located a few steps away from many large favelas. Since 2009, it has been more strongly engaging in debate, research and public policy development aiming drug policy reform, as well as supporting the harm and risk reduction approach towards problematic drug use. On may of 2017, the institution organized, through its Institutional Progam on Alcohol, Crack and other Drugs, the Latin American Seminar on Harm Reduction at the Brazilian National School of Public Health, during which the present letter was drafted together with other Latin American organizations.

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